Donors gambling with patients' lives

International donors are disregarding scientific evidence on the benefits of earlier and expanded treatment for HIV/AIDS. They do so at the expense of the ten million people who are in need of treatment in order to achieve short-term cost savings.

“Today international donors expect doctors to tell patients to come back for treatment when they’re at death’s door,” said Dr. Eric Goemaere, medical coordinator at MSF in South Africa. “This is bad medicine. As a doctor I’d much rather give a patient pills today and send her home than delay treatment and see her in six months at the hospital with complicated tuberculosis.”

MSF will present evidence, including data from its project in the Southern African country of Lesotho, at the international AIDS conference in Vienna this Thursday that shows how earlier treatment reduced the mortality rate and hospitalisation among HIV patients by more than 60 percent.

But this type of research is being ignored by international donors, particularly the United States—the world’s primary HIV treatment donor—which is now advising countries to restrict treatment to those in the more advanced stages of HIV disease.

In addition to medical and financial benefits of starting treatment earlier, studies also show that making treatment widely available at community level is one of the most effective ways to prevent HIV.

Despite this evidence, there is a general trend toward backtracking on HIV funding which will increasingly mean treatment being delayed, deferred, or denied. The Global Fund—the world’s principal funding mechanism for HIV treatment— faces a major financing gap. The US is proposing both continued PEPFAR program flat-funding and a decrease in its contribution to the Global Fund. Just this week, the German media reported top-level discussions to cut its contribution to the Fund three-fold. Austria, the International AIDS Conference host country, has not contributed a single dollar to the Fund since 2001.

This retreat comes after a decade of progress—more than 5.2 million people alive on treatment today—made possible by the emergence of affordable generic drugs and the commitment of donor countries. With 1.2 million people starting treatment in 2009, progress has been rapid. Yet there are still 10 million people waiting to start treatment and the current climate suggests a decreased commitment to fund treatment for those waiting in line.

“Donors repeatedly promised millions of people a lifeline to treatment,” said Goemaere. “It is a matter of choice: will donors help pay for treatment or let people die?